| Name: | Northeast Alabama Dermatology, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 04 Apr 2005 (20 years ago) |
| Entity Number: | 000-462-716 |
| Register Number: | 000462716 |
| County: | Madison |
| Place of Formation: | Madison County |
| Principal Address: | HUNTSVILLE, AL |
| Registered Office Street Address: | 201 SIVLEY ROAD SUITE 410HUNTSVILLE, AL 35801 |
| Registered Office Street Address ZIP Code: | 35801 |
Activities
PROVISION OF DERMATOLOGIC SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174019541 | 2018-07-09 | 2018-07-09 | 201 SIVLEY RD SW STE 410, HUNTSVILLE, AL, 358015146, US | 201 SIVLEY RD SW STE 410, HUNTSVILLE, AL, 358015146, US | |||||||||||||||||||
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| Phone | +1 256-536-3738 |
| Fax | 2565363737 |
Authorized person
| Name | MELINDA BIRCHMORE MUSICK |
| Role | CEO |
| Phone | 2565363738 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| License Number | AL13699 |
| State | AL |
| Is Primary | Yes |
| Name | Role |
|---|---|
| BIRCHMORE-MUSICK, MELINDA | Member |
| Name | Role |
|---|---|
| BIRCHMORE-MUSICK, MELINDA | Agent |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
